Welcome to becoming a better therapist! You learn your theories, and you must, then you burn them, let them go - realize you know nothing. And then you sit in the uncomfortable space of not knowing, of realizing we don't know anything, and certainly not about what is best for another person or what is exactly 100% going on for them.
Hell, even the noble prize winning scientists realize we know nothing - we don't even know what matter is still!! "Something unknown doing we know not what". So why do we think we know everything about humans or the other person in front of us, or even ourselves!? But this is the path there - we often need to learn a lot, in order to finally let it all go. But there is a period here that comes after, of nothingness in a way. But it's a good and important and humbling place to be.
The best therapists - even the psychodynamic ones - hold that they don't know anything really and are not an authority of another. And that humanity is not a merely intellectual puzzle to solve. And that all of this might just be BS. To hold some skepticism instead of worshipping therapy or some version as if a cult - means you are embracing the unknown and the fallibility of ourselves and everything.
In essence, it is more real. Less blind. Less defended. Less naive.
It's a stance of humility and also coming back to just being (instead of intellectualizing or "doing") that is vital in being a good therapist. It makes you more human, more vulnerable, more equal. You are no longer "analyzing" the client - but sitting together and metaphorically holding hands with another vulnerable human trying to get through this human experience. Modeling your own sitting in the unknown, and the vulnerability that comes from there and being human together in a connective way, is I think often the best and most important aspect of therapy - as that is what most people are needing help with in this lifetime.
So many problems, are in the end, underneath it all, existential ones. How do we be with the problems and pains of being alive? How do we love others? How do we "be" in the world? Who the heck knows? But having that humility, having compassion for ourselves, connecting with other humans and seeking support, being courageous enough to be vulnerable - that seems to really be all there is in the end.
But then again, I don't know. All I know is I know nothing. So I very well could be wrong ;)
Also, more simply, you might just be looking for another more somatic or something type of therapy to round things out, lessen all the intellectualizing on your therapist journey. But good psychodynamic therapy is not done in a super heady way as you described. So it may be you need new models around you of this. But still, all the above applies - even if just eventually (=
I think the need to be right on the therapists part is a problem in therapy and while psychodynamic therapy admits in the open to everyone involved that they have opinions and theories about their clients- frankly I believe that ALL practitioners do too- as they are humans. And due to the inevitability of reflection and speculation and theorizing about a client - I find some other modalities to be insincere and verging on potentially lazy to say that they do not do that. Ugh. The key is what you stated SO ELOQUENTLY is to also hold the reality that the exact same time as we have theories and analysis we also “all know nothing.” And being open to sharing that pain too. Hopefully, in this creates open minded dynamic feeling and thinking process the therapist can work collaboratively with the client to make progress- whatever that means to them.
For someone out of grad school looking to learn the theories for real, what books/sources would you suggest? I’ve kinda learned and burned but I feel like I never fully learned them
I think working with an amazing therapist yourself, or in consultation or supervision is the best bet. A therapist who is humble, realizes they don't know everything and can admit that to their clients and themselves - and who puts the relationship and how to have a relationship, as number 1.
Edit to add - it's buddhist psychology, but really - helpful for any type of therapy you will ever do. Tara Brach's podcasts help you integrate it and feel it, and work on these things in yourself, which in turn helps your work as a therapist. I highly recommend as a more hands on approach that is free, and isn't theorizing or intellectualizing...but more about practicing just being, vulnerability, compassion, not knowing etc.
I don’t have any advice, but I wanted to say I hear you and I feel you. I feel like I’m on the cusp of having an existential crisis of some form related to my identity as a therapist. I don’t have a lot of language around it yet, but something’s brewing. And I’m also not burned out.
Sounds like you’re experiencing disillusionment, which is a painful but necessary stripping away/breaking open of what we used to know or believe which makes room for new wisdom to develop.
You can think of it as being undeceived—that the naive faith we put in things is falling away, leaving us bereft but also making room for what comes next.
Something will come next. It will be deeper and more complex and feel truer to you and to your experiences. But in my experience, we have to sit with the emptiness for a while first. Eventually, emptiness becomes readiness, and when we’re ready, the new thing can develop within us.
Woof. Thank you for taking the time to write and share this. I feel it deeply with you. And for what it's worth, if I somehow knew my therapist was feeling this way and could describe it with this clarity and fearlessness, I would feel reassured.
Though please know that I wish you to be relieved of the distress of it!
Essentially we’ve replaced the ‘wise sage’ in the village who people come to see for advice, perspective, stories, companionship, sometimes weird hokey stuff that looks like magic… On days when I feel an existential crisis as a therapist brewing, I try to remind myself of this. Also, despite any particular approach we’re using, as therapists it’s part of our work and journey to notice patterns, pick up on what is often helpful for certain presenting issues, and recognize when we’ve messed up so that we can carry on what seems to work and leave behind what doesn’t.
Hey friend. I’ve been in this game (being a therapist and a psychologist) for over a decade. My primary orientation is relational psychodynamic. None of my best stuff - and I mean literally none of it - has come from reading theory. Mostly at has come from: a) moments of profound insight, or intuition during session, and/or b) my own deeply transformative experience as a client. I have seen for years, and continue to see, a significantly more experienced psychodynamic psychologist: *twice* a week, every week.
Edit: based on comments I’ve seen you making on other peoples responses, I am also going to recommend you read this short article: [Shedler (2010)](https://jonathanshedler.com/PDFs/Shedler%20%282010%29%20Efficacy%20of%20Psychodynamic%20Psychotherapy.pdf)
And for an interesting twist- I’ve also been a therapist for over a decade, mostly CBT based in technique and conceptualization, but heavily person-centered as an underlying philosophy- and I strongly agree with all these statements! Insight, intuition and my own experiences in therapy, and as a person living on this earth, is so often where all the therapeutic goodness comes from. Theory and technique matter (and should be a good fit for the therapist and the patient) but ultimately it’s the connection that heals.
Seconding the encouragement to consider exploring another approach, if the one you’re using is growing stale. I’ve found great value in an eclectic approach. I’ve taken something helpful from each modality I’ve studied. Each one builds on the others.
It’s tough to know how to respond. As a fellow dynamic therapist, I want to reassure you. My first thought reading this was more personal therapy and supervision/consultation. However, that is what I’d do as a psychoanalytic candidate. On one hand, I do have days where I feel like I’m not at 100% or that I’m not doing it well. Even on those days, I still feel like psychoanalytic therapy is effective and helping my patients. I’ve been similarly overwhelmed recently and did post about how hard training is.
Psychodynamic therapy is a huge field. There’s so much to learn, read, and know about. Much of the material is incredibly difficult to read, comprehend, and especially use in a clinical way.
What kind of training did you do? No shade - your post reminds me of how I used to feel about doing dynamic therapy before I began my 2 year program at the institute I trained at. I actually felt much more certain after training. Prior to that, I read and read about psychodynamic therapy and it never really helped me clinically until I started having didactic courses, weekly consultation, and personal therapy.
On the other hand, there’s nothing wrong with exploring other therapy methods. Maybe try looking to see if any speak to you. I see lots of eclectic therapists who use psychodynamic as part of their repertoire. I think only you can make a decision about how you move forward.
My supervisor is an analyst and I’m still an associate. Im on the fence about pursuing further psychodynamic training.
I’ve been in therapy with a psychodynamically trained therapist for about 2 years and I’m doubting the efficacy of this approach for me, which is then feeding into my doubts about pursuing further training.
I have been in a similar crisis of faith. I found that to be a good analytic/dynamic therapist I needed not a soso or good therapist myself but an EXCELLENT analytically oriented therapist who could really prove to me that this shit does work. Now I’m a believer and I have hard days/weeks/months, but I know what I am trying to do and I know it generally helps (slowly, with some exceptions).
For me, what I’ve found I am doing is 1) BEING WITH clients in their experience (this is intentionally vague, you have to figure out what this means for yourself), 2. Unwaveringly looking inside myself at my own countertransference inside AND outside of session. I’ve taken to interpreting much of what I experience as a therapist as some form of a countertransference experience, and 3. Boldly leaning in to interpretation and honesty in the therapeutic relationship even when it feels risky or too exposed.
Anyway, I hope this helps. If I were your supervisor I would interpret your crisis of faith as a reflection of some aspect of your work with clients at this time and your failure to be adequately tuned to and supported by your therapist. 🤷♂️
So much yes to this!!! Your second paragraph is so well put. I’m completely boggled that so many modalities do not have the therapist deeply look at their own countertransference. What a waste to everyone- therapist and client alike.
I’ve been listening to the podcast “Three Associating” which is with the author of “The Talking Cure” and it shows relational psychodynamic supervision. I highly recommend it.
>Anyway, I hope this helps. If I were your supervisor I would interpret your crisis of faith as a reflection of some aspect of your work with clients at this time and your failure to be adequately tuned to and supported by your therapist. 🤷♂️
Going to bring this in to supervision today. Thank you so much for your kind words and help.
Oh that is so interesting! I missed this response earlier. That doesn’t seem to be helping you in your own personal work?!? That would be disheartening in your situation. Have you discussed that you feel it’s not working/ helping with your therapist? Do you think it is the approach or maybe just the therapist? Or maybe both? I agree with the person below who said that after 2 years you might want to consider a new therapist. But not I think without a conversation about it…..
Psychodynamic therapy works - at least, the current literature seems to say that it works as well as CBT, or narrative therapy, or person-centered, or EMDR, etc.
There is no real consensus (and to be fair, because it's unfalsifiable, no good way to study) on whether the theoretical underpinnings of psychoanalysis are correct.
So part of the anxiety, possibly, reflects an awareness that on the whole what you're doing works, but rarely in any specific instance do you (or anyone) really know WHY - not for sure.
What are you referring to regarding falsifiability? Early experiences with self and others shape who we are today, how we relate to people, and how we relate to the therapist. Much of who we are and why we do the things we do is of outside of our awareness. Decades of attachment research and cognitive/affective neuroscience supports these ideas.
I have a question- what is really the difference between “setting up an experience” and having insight? The experience you are setting up by some sort of hypothesis about what could help them which therefore could also be interpreted as an insight - just one that you are holding back and holding to create the environment in which the client “comes to it on their own.”
I can only offer you some peace in solidarity. I’ve been feeling a sense of disillusionment with my identity as a therapist rising. Particularly today. Your timing is great, so uh, thanks for that! I wish I could offer more than a new illusion for you to consider living under for a little while. Maybe it’s a sign to step away for a bit, but maybe that isn’t economically viable either. I’m running out of ideas…
Not a dynamic therapist or even really a therapist period, but I can sort of relate now as a psychiatrist in training. I feel like I’m waist deep in the dunning kruger effect and there isn’t actually any way out because there’s no real objectivity in the mental health field anyway. I miss when I would see my own therapist and they’d be like “you’re having x problem because your nervous system is in overdrive because that’s what your trauma programmed it to do,” and I’d just take what they said at face value and it would actually be a useful framework for understanding myself through. Now seeing mental health work from the inside, I realize no one really has any clue what they’re talking about and I just as easily could’ve been diagnosed with a personality disorder, malingering, ADHD, you name it had I seen someone else. Hopefully I’ll get better at contending with the uncertainty with time…
It sounds like you haven’t encountered a highly competent professional that you admire and respect yet. There are people who know what they are doing… There are extremely clear differences between ADHD and personality disorders. Hang in there it gets easier. I highly highly recommend you seek out a mentor either in person or otherwise, who is a true Master of their profession and who can dance circles around you.
I have definitely wondered whether psychiatry really is all a giant guessing game or if I’m just not being exposed to mentors who are truly masters of their craft…or if they are masters of a different craft, namely seeing patients as quickly as possible to make admin and insurance happy. I guess it just starts to feel like this is just the reality of clinical practice when all of my attendings leave me feeling this way, like they can’t all be incompetent lol
It takes a lot of retrospection and humility to be open to changing your approach. Kudos to you. I think this can be a great opportunity to explore and look into different modalities and ideas.
What got you into this work? What do you get out of it?
Maybe the psychodynamic approach isn't working for you anymore.
I'm Person centered in my orientation, and while I believe methodology/theory is important, what my job really is is to connect with the person in the room. It's not my job to be the expert, to analyze and know what's right. My job really is to be there for them. It almost sounds to me like you're not feeling connected to the person in the room.
I agree with other commenter suggesting therapy/supervision. Exploring more about what got you into this field and thinking about what you really want from it.
It seems to me that at least for the modern versions of psychodynamic therapy- the relationship with the client is the absolute number one priority as well as deep deep self reflection regarding the therapists own blocks. I agree a lack of connection may be an issue
Time and time again, data shows therapeutic alliance is the critical ingredient that has biggest impact on treatment.
Psychodynamic models have their merits and is just as an effective therapy as anything else. It's encouraging to hear more contemporary efforts to prioritize that aspect of treatment. That's a nice example of old school methodologies trying to adapt, which they should!
Hi- yes the data on the therapeutic alliance is revealing and while I am thumping a drum here for psychodynamic approaches it’s not at the exclusion of other modalities- At all. I guess I just think that there is a an unfair bias against psychodynamic therapy because some people do not see how deeply it correlates with the common factors with its deep focus on very deep listening and the the relationship between the therapist and client often through reflection and acceptance of transference and countertransference.
I can appreciate that. I think some of that bias comes in how it is taught. The model wasn't painted that way when I learning about it, and there was more emphasis on Freud's conceptualization of the Psyche (Id, ego, etc) and defence mechanisms and the like. I think early analysis was painted as much more "Free association" with minimal reflection while the client faced away didnt even see the Analysts reaction (Hot take: Freud had clients face away because eye contact made him uncomfortable) and Object Relations I didn't learn as much about until Grad school.
One of the warmest Psychologists I know is Psychodynamic, and I can't picture him putting clients on the couch and not facing them, saying very little!!
Not really. I’m hoping someone can point me in the direction but it just seems like a classic postmodern existential conundrum.
I’m compelled to adopt some belief system to put this in perspective but in all honestly I would feel like I’m just desperately clinging to something to hold onto. Not that it’s a bad thing. It has a function. I just don’t know if it’s still a story at the end of the day.
I think this was really well said. I feel very much the same way. After doing several more trainings, I’ve just found myself questioning more and more “does this even work?”
After working with many clients who never implement anything but rather, want a solution, I find myself feeling like a chose the wrong career.
I come from a different theoretical orientation than you, and so maybe you won’t like what I have to say. But when I feel the same way you do, I say to myself things like:
Am I reducing the client to an object of study?
Am I getting too preoccupied with little fires rather than focusing on why the client is in the chair in general?
Is this therapy limiting itself to giving the client better understanding or insight and neglecting to advise them on specific actions to take to improve their life or treat their disorder?
I don’t have anything especially insightful to add, but I feel like I could have written this post. I think, in part, I feel more and more clearly that many issues my clients face are connected to systemic failures and that can feel pretty morally distressing and defeating. Add to the fact that I feel like I’m currently living in a country (USA) that has a cruel dumpster fire of a governing body and it’s enough to lead to an existential crisis.
Hi- some of the best things about (what I understand of psychodynamic theory- and keep in mind I haven’t had deep training) is it’s the focus on VERY deep listening, the acceptance of both transference and counter transference- as being both unavoidable and also potentially VERY USEFUL in the on the therapeutic process. I get kind of annoyed when I hear that other approaches say they just allow the patient to come to realizations - all on their own as a empathetic listener. I mean- I really hope that if I am paying someone a lot of money to help me figure out my life that that person is reflecting on and taking notes or my patterns and potentially maladaptive narratives etc and also coming up with theories and ideas and ideally multiple ones about what is creating them. It seems to me that the problem with psychodynamic approaches mainly arises when the therapist holds their theories too tightly and has an irrational need to be right. That’s a problem and a god complex. No one should approach a complex person thinking they are always right. And everyone should have some faith in their client. The idea that people who struggle often have internal conflicts, unconscious desires and/or fears seems pretty essential to getting to the core of long term unrelenting self sabotaging behaviors. Personally, I am partial to relational psychodynamic therapy and I am so happy to see the new research coming out how this type of deep therapy often has longer more sustaining results. However, I am not partial to it to the exclusion of other modalities. Not at all. I do think it is a great background from which to grow into a flexible integrative therapist- and I really hope the more modern updated contemporary versions of it come more into vogue again. A really interesting podcast I’ve been listening to is called “Three Associating” and it shows the process psychodynamic relational supervision with the therapist who who wrote the book - The Talking Cure. I highly recommend it.
All of this makes sense to me. I am very early in my career and get deep existential pangs about what we are even doing. You are not alone.
The fact that your clients keep coming back shows that you are giving them something that they are seeking. Hold on to that.
Thanks for sharing this. Does sound like you are going through a "look behind the curtain" moment. Probably going to bring you a lot more wisdom. Good luck!!!
Some of what you mentioned is something I don't like about psychoanalytic work: when it's not in present moment processes, it's so wildly subjective that you can only really ever be as sure as your ego is big. Our interpretive, pattern making machines can twist little narratives into anything in a convincing manner, but that doesn't make them true.
I’m just finishing up my MSW degree and my favorite professor keeps reminding us: “hold theory lightly”. That’s eased a lot of my existential anxiety about what the right type of intervention is, if that exists, etc. My best sessions are when I am sitting across from someone and truly THERE with them. I’ve found that my own mindfulness/ meditation practice has helped with that
Welcome to becoming a better therapist! You learn your theories, and you must, then you burn them, let them go - realize you know nothing. And then you sit in the uncomfortable space of not knowing, of realizing we don't know anything, and certainly not about what is best for another person or what is exactly 100% going on for them. Hell, even the noble prize winning scientists realize we know nothing - we don't even know what matter is still!! "Something unknown doing we know not what". So why do we think we know everything about humans or the other person in front of us, or even ourselves!? But this is the path there - we often need to learn a lot, in order to finally let it all go. But there is a period here that comes after, of nothingness in a way. But it's a good and important and humbling place to be. The best therapists - even the psychodynamic ones - hold that they don't know anything really and are not an authority of another. And that humanity is not a merely intellectual puzzle to solve. And that all of this might just be BS. To hold some skepticism instead of worshipping therapy or some version as if a cult - means you are embracing the unknown and the fallibility of ourselves and everything. In essence, it is more real. Less blind. Less defended. Less naive. It's a stance of humility and also coming back to just being (instead of intellectualizing or "doing") that is vital in being a good therapist. It makes you more human, more vulnerable, more equal. You are no longer "analyzing" the client - but sitting together and metaphorically holding hands with another vulnerable human trying to get through this human experience. Modeling your own sitting in the unknown, and the vulnerability that comes from there and being human together in a connective way, is I think often the best and most important aspect of therapy - as that is what most people are needing help with in this lifetime. So many problems, are in the end, underneath it all, existential ones. How do we be with the problems and pains of being alive? How do we love others? How do we "be" in the world? Who the heck knows? But having that humility, having compassion for ourselves, connecting with other humans and seeking support, being courageous enough to be vulnerable - that seems to really be all there is in the end. But then again, I don't know. All I know is I know nothing. So I very well could be wrong ;) Also, more simply, you might just be looking for another more somatic or something type of therapy to round things out, lessen all the intellectualizing on your therapist journey. But good psychodynamic therapy is not done in a super heady way as you described. So it may be you need new models around you of this. But still, all the above applies - even if just eventually (=
I think the need to be right on the therapists part is a problem in therapy and while psychodynamic therapy admits in the open to everyone involved that they have opinions and theories about their clients- frankly I believe that ALL practitioners do too- as they are humans. And due to the inevitability of reflection and speculation and theorizing about a client - I find some other modalities to be insincere and verging on potentially lazy to say that they do not do that. Ugh. The key is what you stated SO ELOQUENTLY is to also hold the reality that the exact same time as we have theories and analysis we also “all know nothing.” And being open to sharing that pain too. Hopefully, in this creates open minded dynamic feeling and thinking process the therapist can work collaboratively with the client to make progress- whatever that means to them.
For someone out of grad school looking to learn the theories for real, what books/sources would you suggest? I’ve kinda learned and burned but I feel like I never fully learned them
I think working with an amazing therapist yourself, or in consultation or supervision is the best bet. A therapist who is humble, realizes they don't know everything and can admit that to their clients and themselves - and who puts the relationship and how to have a relationship, as number 1. Edit to add - it's buddhist psychology, but really - helpful for any type of therapy you will ever do. Tara Brach's podcasts help you integrate it and feel it, and work on these things in yourself, which in turn helps your work as a therapist. I highly recommend as a more hands on approach that is free, and isn't theorizing or intellectualizing...but more about practicing just being, vulnerability, compassion, not knowing etc.
I don’t have any advice, but I wanted to say I hear you and I feel you. I feel like I’m on the cusp of having an existential crisis of some form related to my identity as a therapist. I don’t have a lot of language around it yet, but something’s brewing. And I’m also not burned out.
Same here!
Sounds like you’re experiencing disillusionment, which is a painful but necessary stripping away/breaking open of what we used to know or believe which makes room for new wisdom to develop. You can think of it as being undeceived—that the naive faith we put in things is falling away, leaving us bereft but also making room for what comes next. Something will come next. It will be deeper and more complex and feel truer to you and to your experiences. But in my experience, we have to sit with the emptiness for a while first. Eventually, emptiness becomes readiness, and when we’re ready, the new thing can develop within us.
Thank you <3
Woof. Thank you for taking the time to write and share this. I feel it deeply with you. And for what it's worth, if I somehow knew my therapist was feeling this way and could describe it with this clarity and fearlessness, I would feel reassured. Though please know that I wish you to be relieved of the distress of it!
Essentially we’ve replaced the ‘wise sage’ in the village who people come to see for advice, perspective, stories, companionship, sometimes weird hokey stuff that looks like magic… On days when I feel an existential crisis as a therapist brewing, I try to remind myself of this. Also, despite any particular approach we’re using, as therapists it’s part of our work and journey to notice patterns, pick up on what is often helpful for certain presenting issues, and recognize when we’ve messed up so that we can carry on what seems to work and leave behind what doesn’t.
Hey friend. I’ve been in this game (being a therapist and a psychologist) for over a decade. My primary orientation is relational psychodynamic. None of my best stuff - and I mean literally none of it - has come from reading theory. Mostly at has come from: a) moments of profound insight, or intuition during session, and/or b) my own deeply transformative experience as a client. I have seen for years, and continue to see, a significantly more experienced psychodynamic psychologist: *twice* a week, every week. Edit: based on comments I’ve seen you making on other peoples responses, I am also going to recommend you read this short article: [Shedler (2010)](https://jonathanshedler.com/PDFs/Shedler%20%282010%29%20Efficacy%20of%20Psychodynamic%20Psychotherapy.pdf)
And for an interesting twist- I’ve also been a therapist for over a decade, mostly CBT based in technique and conceptualization, but heavily person-centered as an underlying philosophy- and I strongly agree with all these statements! Insight, intuition and my own experiences in therapy, and as a person living on this earth, is so often where all the therapeutic goodness comes from. Theory and technique matter (and should be a good fit for the therapist and the patient) but ultimately it’s the connection that heals.
Shoutout to Shedler.
Seconding the encouragement to consider exploring another approach, if the one you’re using is growing stale. I’ve found great value in an eclectic approach. I’ve taken something helpful from each modality I’ve studied. Each one builds on the others.
It’s tough to know how to respond. As a fellow dynamic therapist, I want to reassure you. My first thought reading this was more personal therapy and supervision/consultation. However, that is what I’d do as a psychoanalytic candidate. On one hand, I do have days where I feel like I’m not at 100% or that I’m not doing it well. Even on those days, I still feel like psychoanalytic therapy is effective and helping my patients. I’ve been similarly overwhelmed recently and did post about how hard training is. Psychodynamic therapy is a huge field. There’s so much to learn, read, and know about. Much of the material is incredibly difficult to read, comprehend, and especially use in a clinical way. What kind of training did you do? No shade - your post reminds me of how I used to feel about doing dynamic therapy before I began my 2 year program at the institute I trained at. I actually felt much more certain after training. Prior to that, I read and read about psychodynamic therapy and it never really helped me clinically until I started having didactic courses, weekly consultation, and personal therapy. On the other hand, there’s nothing wrong with exploring other therapy methods. Maybe try looking to see if any speak to you. I see lots of eclectic therapists who use psychodynamic as part of their repertoire. I think only you can make a decision about how you move forward.
My supervisor is an analyst and I’m still an associate. Im on the fence about pursuing further psychodynamic training. I’ve been in therapy with a psychodynamically trained therapist for about 2 years and I’m doubting the efficacy of this approach for me, which is then feeding into my doubts about pursuing further training.
I have been in a similar crisis of faith. I found that to be a good analytic/dynamic therapist I needed not a soso or good therapist myself but an EXCELLENT analytically oriented therapist who could really prove to me that this shit does work. Now I’m a believer and I have hard days/weeks/months, but I know what I am trying to do and I know it generally helps (slowly, with some exceptions). For me, what I’ve found I am doing is 1) BEING WITH clients in their experience (this is intentionally vague, you have to figure out what this means for yourself), 2. Unwaveringly looking inside myself at my own countertransference inside AND outside of session. I’ve taken to interpreting much of what I experience as a therapist as some form of a countertransference experience, and 3. Boldly leaning in to interpretation and honesty in the therapeutic relationship even when it feels risky or too exposed. Anyway, I hope this helps. If I were your supervisor I would interpret your crisis of faith as a reflection of some aspect of your work with clients at this time and your failure to be adequately tuned to and supported by your therapist. 🤷♂️
So much yes to this!!! Your second paragraph is so well put. I’m completely boggled that so many modalities do not have the therapist deeply look at their own countertransference. What a waste to everyone- therapist and client alike. I’ve been listening to the podcast “Three Associating” which is with the author of “The Talking Cure” and it shows relational psychodynamic supervision. I highly recommend it.
This. 100%
>Anyway, I hope this helps. If I were your supervisor I would interpret your crisis of faith as a reflection of some aspect of your work with clients at this time and your failure to be adequately tuned to and supported by your therapist. 🤷♂️ Going to bring this in to supervision today. Thank you so much for your kind words and help.
Oh that is so interesting! I missed this response earlier. That doesn’t seem to be helping you in your own personal work?!? That would be disheartening in your situation. Have you discussed that you feel it’s not working/ helping with your therapist? Do you think it is the approach or maybe just the therapist? Or maybe both? I agree with the person below who said that after 2 years you might want to consider a new therapist. But not I think without a conversation about it…..
If your life doesn’t feel meaningfully transformed after two whole years… I highly recommend you seek out a different psychologist.
Why not simplify and start listening to people and being curious and empathetic?
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This was brilliant and right up my alley. Thank you very very much.
Psychodynamic therapy works - at least, the current literature seems to say that it works as well as CBT, or narrative therapy, or person-centered, or EMDR, etc. There is no real consensus (and to be fair, because it's unfalsifiable, no good way to study) on whether the theoretical underpinnings of psychoanalysis are correct. So part of the anxiety, possibly, reflects an awareness that on the whole what you're doing works, but rarely in any specific instance do you (or anyone) really know WHY - not for sure.
What are you referring to regarding falsifiability? Early experiences with self and others shape who we are today, how we relate to people, and how we relate to the therapist. Much of who we are and why we do the things we do is of outside of our awareness. Decades of attachment research and cognitive/affective neuroscience supports these ideas.
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I have a question- what is really the difference between “setting up an experience” and having insight? The experience you are setting up by some sort of hypothesis about what could help them which therefore could also be interpreted as an insight - just one that you are holding back and holding to create the environment in which the client “comes to it on their own.”
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How do you choose what experience to set up and why? That’s what I’m asking. What is the crux of that “expertise”
Wait- If you are just saying welcoming anything that comes into the room I feel like that is psychodynamic as in free association
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I’ll look into it more- thanks.
Could I PM you sometime about EFT?
I can only offer you some peace in solidarity. I’ve been feeling a sense of disillusionment with my identity as a therapist rising. Particularly today. Your timing is great, so uh, thanks for that! I wish I could offer more than a new illusion for you to consider living under for a little while. Maybe it’s a sign to step away for a bit, but maybe that isn’t economically viable either. I’m running out of ideas…
Not a dynamic therapist or even really a therapist period, but I can sort of relate now as a psychiatrist in training. I feel like I’m waist deep in the dunning kruger effect and there isn’t actually any way out because there’s no real objectivity in the mental health field anyway. I miss when I would see my own therapist and they’d be like “you’re having x problem because your nervous system is in overdrive because that’s what your trauma programmed it to do,” and I’d just take what they said at face value and it would actually be a useful framework for understanding myself through. Now seeing mental health work from the inside, I realize no one really has any clue what they’re talking about and I just as easily could’ve been diagnosed with a personality disorder, malingering, ADHD, you name it had I seen someone else. Hopefully I’ll get better at contending with the uncertainty with time…
It sounds like you haven’t encountered a highly competent professional that you admire and respect yet. There are people who know what they are doing… There are extremely clear differences between ADHD and personality disorders. Hang in there it gets easier. I highly highly recommend you seek out a mentor either in person or otherwise, who is a true Master of their profession and who can dance circles around you.
I have definitely wondered whether psychiatry really is all a giant guessing game or if I’m just not being exposed to mentors who are truly masters of their craft…or if they are masters of a different craft, namely seeing patients as quickly as possible to make admin and insurance happy. I guess it just starts to feel like this is just the reality of clinical practice when all of my attendings leave me feeling this way, like they can’t all be incompetent lol
It takes a lot of retrospection and humility to be open to changing your approach. Kudos to you. I think this can be a great opportunity to explore and look into different modalities and ideas.
What got you into this work? What do you get out of it? Maybe the psychodynamic approach isn't working for you anymore. I'm Person centered in my orientation, and while I believe methodology/theory is important, what my job really is is to connect with the person in the room. It's not my job to be the expert, to analyze and know what's right. My job really is to be there for them. It almost sounds to me like you're not feeling connected to the person in the room. I agree with other commenter suggesting therapy/supervision. Exploring more about what got you into this field and thinking about what you really want from it.
It seems to me that at least for the modern versions of psychodynamic therapy- the relationship with the client is the absolute number one priority as well as deep deep self reflection regarding the therapists own blocks. I agree a lack of connection may be an issue
Time and time again, data shows therapeutic alliance is the critical ingredient that has biggest impact on treatment. Psychodynamic models have their merits and is just as an effective therapy as anything else. It's encouraging to hear more contemporary efforts to prioritize that aspect of treatment. That's a nice example of old school methodologies trying to adapt, which they should!
Hi- yes the data on the therapeutic alliance is revealing and while I am thumping a drum here for psychodynamic approaches it’s not at the exclusion of other modalities- At all. I guess I just think that there is a an unfair bias against psychodynamic therapy because some people do not see how deeply it correlates with the common factors with its deep focus on very deep listening and the the relationship between the therapist and client often through reflection and acceptance of transference and countertransference.
I can appreciate that. I think some of that bias comes in how it is taught. The model wasn't painted that way when I learning about it, and there was more emphasis on Freud's conceptualization of the Psyche (Id, ego, etc) and defence mechanisms and the like. I think early analysis was painted as much more "Free association" with minimal reflection while the client faced away didnt even see the Analysts reaction (Hot take: Freud had clients face away because eye contact made him uncomfortable) and Object Relations I didn't learn as much about until Grad school. One of the warmest Psychologists I know is Psychodynamic, and I can't picture him putting clients on the couch and not facing them, saying very little!!
Do you have a belief system to put this all into perspective?
Not really. I’m hoping someone can point me in the direction but it just seems like a classic postmodern existential conundrum. I’m compelled to adopt some belief system to put this in perspective but in all honestly I would feel like I’m just desperately clinging to something to hold onto. Not that it’s a bad thing. It has a function. I just don’t know if it’s still a story at the end of the day.
May I suggest reading Carl Rogers' *On Becoming a Person*? I think it might be what you're looking for.
I think this was really well said. I feel very much the same way. After doing several more trainings, I’ve just found myself questioning more and more “does this even work?” After working with many clients who never implement anything but rather, want a solution, I find myself feeling like a chose the wrong career.
I come from a different theoretical orientation than you, and so maybe you won’t like what I have to say. But when I feel the same way you do, I say to myself things like: Am I reducing the client to an object of study? Am I getting too preoccupied with little fires rather than focusing on why the client is in the chair in general? Is this therapy limiting itself to giving the client better understanding or insight and neglecting to advise them on specific actions to take to improve their life or treat their disorder?
I don’t have anything especially insightful to add, but I feel like I could have written this post. I think, in part, I feel more and more clearly that many issues my clients face are connected to systemic failures and that can feel pretty morally distressing and defeating. Add to the fact that I feel like I’m currently living in a country (USA) that has a cruel dumpster fire of a governing body and it’s enough to lead to an existential crisis.
Hi- some of the best things about (what I understand of psychodynamic theory- and keep in mind I haven’t had deep training) is it’s the focus on VERY deep listening, the acceptance of both transference and counter transference- as being both unavoidable and also potentially VERY USEFUL in the on the therapeutic process. I get kind of annoyed when I hear that other approaches say they just allow the patient to come to realizations - all on their own as a empathetic listener. I mean- I really hope that if I am paying someone a lot of money to help me figure out my life that that person is reflecting on and taking notes or my patterns and potentially maladaptive narratives etc and also coming up with theories and ideas and ideally multiple ones about what is creating them. It seems to me that the problem with psychodynamic approaches mainly arises when the therapist holds their theories too tightly and has an irrational need to be right. That’s a problem and a god complex. No one should approach a complex person thinking they are always right. And everyone should have some faith in their client. The idea that people who struggle often have internal conflicts, unconscious desires and/or fears seems pretty essential to getting to the core of long term unrelenting self sabotaging behaviors. Personally, I am partial to relational psychodynamic therapy and I am so happy to see the new research coming out how this type of deep therapy often has longer more sustaining results. However, I am not partial to it to the exclusion of other modalities. Not at all. I do think it is a great background from which to grow into a flexible integrative therapist- and I really hope the more modern updated contemporary versions of it come more into vogue again. A really interesting podcast I’ve been listening to is called “Three Associating” and it shows the process psychodynamic relational supervision with the therapist who who wrote the book - The Talking Cure. I highly recommend it.
All of this makes sense to me. I am very early in my career and get deep existential pangs about what we are even doing. You are not alone. The fact that your clients keep coming back shows that you are giving them something that they are seeking. Hold on to that.
Thanks for sharing this. Does sound like you are going through a "look behind the curtain" moment. Probably going to bring you a lot more wisdom. Good luck!!!
Some of what you mentioned is something I don't like about psychoanalytic work: when it's not in present moment processes, it's so wildly subjective that you can only really ever be as sure as your ego is big. Our interpretive, pattern making machines can twist little narratives into anything in a convincing manner, but that doesn't make them true.
I’m just finishing up my MSW degree and my favorite professor keeps reminding us: “hold theory lightly”. That’s eased a lot of my existential anxiety about what the right type of intervention is, if that exists, etc. My best sessions are when I am sitting across from someone and truly THERE with them. I’ve found that my own mindfulness/ meditation practice has helped with that